XXY Early Intervention

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Traditionally termed allied health, children’s therapy services generally include occupational therapy, speech therapy, physiotherapy, and may also include dieticians, orthotists, podiatrist and others.

It is important to remember that to achieve the best outcomes for a child with a Klinefelter syndrome/XXY diagnoses a collaborative approach is vital, this team should consist of a GP, Paediatrician, endocrinologist and potentially a child psychologist and/or psychiatrist if mental health concerns are identified. It is very important that the parents are actively involved in this team and collaborate about decision making and intervention options that are needed.

Klinefelter Syndrome/XXY is a broad spectrum with some children only displaying mild signs and symptoms and others being more affected. The following symptoms may be evident in children with this diagnoses:

• Low muscle tone: 68% will have hypotonia
• Speech delay/expressive language disorder: 70%-80% will have language difficulties.
• Mild autism: 11-27% of children and adolescents are diagnosed with autism
• Subtle developmental delays eg. Grabbing objects, crawling, walking, talking etc.
• Learning disability: It is believed that 50% – 75% throughout childhood will be diagnosed with a reading disorder
• Attention deficits: This is very common with 63% of children diagnosed with ADHD
• Depression/anxiety: Research suggests affects up to 70% of children and adolescents
• Sensory processing challenges: Are very common and may include aversion to loud noises or over stimuli in busy environments
• Social and interaction difficulties: This is often as a result of the above listed
• Micro phallus: Very common
• Hypogonadism (low levels of testosterone)

There is no cure for Klinefelter Syndrome/XXY but with the right early childhood intervention the impacts can be greatly minimised. Children can go on to live a happy and fulfilling life and be successful in their chosen field if they have the right support mechanisms in place.

What is early childhood intervention?

Early childhood intervention is the process of providing services, education and support to infants and young children who are deemed to have an established condition, like Klinefelter syndrome/XXY, those who are evaluated and deemed to have a diagnosed physical or mental condition, with a high probability of resulting in a developmental delay, which is often evident in young children with Klinefelter syndrome/XXY. This can also be a trigger for children who don’t have a diagnoses to seek further testing particularly if hypotonia and developmental delays are present.

Klinefelter’s syndrome/XXY is the most common chromosome disorder in males but is often not well understood or knowledge and awareness is minimal. Early childhood intervention professionals can help bridge the gap of delayed and miss diagnoses. It is important for early childhood intervention professionals to understand the array of signs and symptoms that can be present for an infant and young child with Klinefelter syndrome/XXY. If they see these signs and symptoms and suspect a diagnoses they should be proactive and refer the parent back to a GP or to a paediatrician for further karyotyping blood tests.

The purpose of early childhood intervention is to lessen the effects of the disability or delays. Services are designed to identify and meet a child’s needs in five developmental areas, including:

• Physical development: (reaching, sitting, rolling, crawling, and walking, pencil grip);
• Cognitive development (thinking, learning, solving problems);
• Communication (talking, listening, understanding);
• Social or emotional development (playing, feeling secure and happy, emotion regulation); and
• Adaptive and self-help development (eating, dressing etc).

Early intervention programs and services may occur in a variety of settings, with a heavy emphasis on natural environments and play based therapy, these may include; the home environment, pre-schools, kindergartens, primary schools and early childhood intervention clinics. These programs and/or services are proven to be most effective when started as soon as the delay or disability is identified.

It is vital that parents don’t take the wait and see approach and that they are proactive in getting their infant or young child assessed and to implement early childhood intervention as soon as any delays or concerns are identified. Delaying early childhood intervention can be detrimental to a child’s potential. Early childhood intervention offers a child the best chance for success in the future.

Services may also be provided to address the needs and priorities of the child’s family. Family-directed services are meant to help family members understand the special needs of their child and how to enhance his or her development.

The early childhood intervention team

Speech Pathologists

What do speech pathologists do?
Speech pathologists assess, diagnose and treat communication and swallowing difficulties in children and adults. Communication difficulties refer to challenges with speaking, understanding and/or using language, listening, social skills, stuttering, reading, writing and using voice. Speech pathologists also help people who have difficulties eating and drinking safely.

It is known that young children with Klinefelter syndrome/XXY experience language difficulties. In fact, 70% – 80% of children with tis diagnoses will experience language difficulties. These challenges and difficulties are around language acquisition of the mainstages of language development and mainly affect articulation and expressive language rather than receptive language. It has been identified that the sooner speech therapy is implemented if delays are identified the quicker a child will catch up to their peers.

Where do speech pathologists work?
Speech pathologists can work with families and children in many different settings including; pre-schools, schools, in the home, community health centres and private practice. Speech pathologists often work collaboratively with occupational therapists, physiotherapists, dietitians, audiologists, psychologists, doctors and teachers.

How can a speech pathologist help a child with Klinefelter syndrome/XXY?
Speech pathologists can support people in the following areas:

• Speech delays and disorders – articulation and producing speech sounds
• Expressive language – using language to share thoughts, feelings and ideas
• Receptive language – understanding language, word meanings and instructions
• Augmentative and alternative communication for people with difficulties speaking and writing e.g. using pictures, communication boards or assistive devices to support understanding and expression of language
• Fluency – supporting people who stutter to speak more fluently and with confidence
• Feeding and swallowing difficulties – supporting infants, children and adults who have difficulties eating, drinking and swallowing safely. Not common but can occur with infants and young children with significant hypotonia
• Pre literacy and literacy skills – learning to read, write and spell
• Social communication difficulties – communicating for social purposes and following the rules for conversation
• Cognitive-communication disorders – organising thoughts, planning, reasoning, paying attention, remembering and problem solving
• Aural rehabilitation for people who are deaf or hard of hearing

Research suggests that using an apraxia speech therapy framework for a child with a Klinefelter syndrome/XXY diagnoses is the most beneficial.

Speech Pathology Australia resources and fact sheets

Occupational Therapist

What do occupational therapists do?

Occupational therapy is a person-centred health profession concerned with promoting health and well-being of children and individuals. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with children and families to enhance their ability to engage in activities of daily living and assesses what they want to do, need to do, or are expected to do, or by modifying the environment to better support their ability to engage and interact.

Your child might see an occupational therapist if he has difficulty doing everyday activities. His difficulties might be the result of physical, psychological or emotional problems, developmental delay or intellectual disability. These delays are often a direct correlation to the signs and symptoms evident with Klinefelter syndrome/XXY.

How can an occupational therapist help a child with Klinefelter syndrome/XXY?

An occupational therapist work with children who can’t take full part in everyday life for some reason. The occupational therapists job is to help your child develop independent living skills and participate to the best of his ability in everyday activities. They can come to the home environment, pre-school, primary school or a child can be seen in their clinical practice rooms.

Occupational therapists consider all areas of your child’s development, including thinking, speech, language, social skills, gross motor skills and fine motor skills. Occupational therapists also look at your child’s environment, including physical, social or legislative barriers that can make life hard for your child, and try to find ways of improving the environment or working around these barriers. They work in collaboration with parents, pre-school educators, health professionals, other early childhood intervention therapists and teachers to ensure the best outcomes for the child.

These are some great activities and things you can do at home, find out more and try them.

Physiotherapist

What do physiotherapists do?

Research suggests that hypotonia is evident in 68% of children with a Klinefelter syndrome/XXY diagnoses. This can affect every aspect of their lives.

It is beneficial for parents of children with a Klinefelter syndrome/XXY diagnoses to take their children to see a Paediatric physiotherapist, they are physiotherapists who specialise in working with children from birth to late adolescence. They usually have further training and experience such as a graduate diploma in paediatrics or a masters degree.

Physiotherapists often work with children with developmental or physical challenges like Klinefelter syndrome/XXY to help them with physical and motor skills problems. The most common need arising from hypotonia which greatly affects a child’s core muscles.

Paediatric physiotherapists have expert skills in the assessment, identification and diagnosis of, and treatment of child development and movement difficulties. They have highly developed hands on skills, which they use with a big dash of fun, creativity and playfulness, to develop individualised therapy programs for each child.

The significant impact that hypotonia can have on a child with Klinefelter syndrome/XXY has been indicated in research papers. Generalised hypotonia can increase fatigue, decrease ability to sit and engage in activities and can result in behavioural outbursts to compensate. Hypotonia can affect a child’s gross and fine motor skills.

How can a physio pathologist help a child with Klinefelter syndrome/XXY?

A physiotherapist can help your child with:

• Hypotonia – Low muscle tone
• Problems with balance, posture, coordination and general motor skills
• Joint, muscle or nerve problems that are causing weakness or pain
• To improve strength, movement, function and independence.

Physiotherapists who work with children will want parents to be involved in their child’s sessions and in planning for their child’s treatment. Good communication with families is very important to paediatric physiotherapists.

The types of movement disorders or movement difficulties paediatric physiotherapists can help with vary greatly, but can include:

• Babies and children who are slower to achieve their motor milestones, eg: babies who are late to learn to sit, crawl or walk
• Babies and children who are using unusual patterns to move eg: w-sitting or bottom shuffling or toe walking
• Children who are having difficulty with motor skills, such as jumping/hopping or ball skills
• Toddlers and babies who are clumsy or uncoordinated
• Children with disabilities such as Klinefelter syndrome/XXY, hypotonia and diastasis recti

They collaborate with the child, the child’s family, other health professionals and teachers or educators. Treatment and therapy programs aim to optimise the health, well-being, and abilities of each child to enable them to move and participate in everyday activities, like playing, learning, going to school, and being part of a family and community.

The more active families are in implementing suggested early intervention therapies and regimes the more positive outcomes for a child with Klinefelter syndrome/XXY.

Additional Resources